Appl Clin Inform 2010; 01(04): 363-376
DOI: 10.4338/ACI-2010-07-CR-0041
Case Report
Schattauer GmbH

Lessons Learned from Implementation of Information and Communication Technologies in Spain’s Healthcare Services

Issues and Opportunities
J. Carnicero
1   Observatory of the National Health System. Ministry of Health and Social Policy
,
D. Rojas
2   Spain; Independent Consultant, Spain
› Institutsangaben
Weitere Informationen

Correspondence to:

Javier Carnicero
Observatory of the National Health System
Ministry of Health and Social Policy
Office 1605
Paseo del Prado 18-20
28014 Madrid
Spain

Publikationsverlauf

received: 20. Juli 2010

accepted: 02. Oktober 2010

Publikationsdatum:
16. Dezember 2017 (online)

 

Summary

Background: Spain’s health services have undertaken a number of important projects aimed at the creation of Electronic Health Records (EHR) through the incorporation of Information and Communication Technologies (ICT) into patient care practices. The objective of this endeavor is to improve care quality and efficiency and increase responsiveness to the population‘s needs and demands. Between 2006-2009 over 300 million Euro were invested in projects of this type.

Objective: To better understand the success criteria, the difficulties encountered and certain issues that must be kept in mind to ensure successful implementation of ICT projects in health organizations, based on Spain‘s experiences in this field.

Methods: The projects’ results are analyzed using the criteria of compliance with the expected scope, cost and time frame.

Results: The results can be considered satisfactory in primary care facilities, where almost 90% of Spain‘s general practitioners, pediatricians and primary care nurses are using electronic health record (EHR) systems. In hospitals EHR implementation is more uneven. Over 40% of Spanish primary care centers and 42% of pharmacies are using electronic prescription (the information system that connects the physician to the dispensing pharmacy and the dispensing pharmacy to the payer).

Discussion: All of Spain’s health services are currently carrying out projects involving ICT application in healthcare, and a priori the benefits of ICT are not questioned. However, the costs and time frames required for these projects are clearly surpassing initial expectations, while the benefits perceived by both professionals and institutions remain limited. This situation may be due in part to the absence of a project management culture in the health services, which has led them to pay insufficient attention to the main difficulties and key issues related to the implementation of EHR.


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Conflicts of interest

The authors declare that they have no conflicts of interest regarding the contents of this paper and that this paper reflects the personal opinions of its authors and not the position of the Observatory of the National Health System (Quality Agency of Spain’s Ministry of Health and Social Policy).

  • References

  • 1 Spanish Ministry of Health and Social Policy.. National Health System of Spain Annual Report 2008. Madrid: Ministry of Health and Social Policy; 2010: 464 p.
  • 2 National Observatory for Telecommunications and the Information Society.. Information and Communication Technologies in the National Health System Report. Madrid: Spanish Ministry of Industry, Tourism and Commerce; 2010: 26 p.
  • 3 Carnicero J. compiler and editor. La gestión de proyectos de tecnologías de la información y de las comunicaciones en los servicios de salud –Informe SEIS (7). Pamplona: Sociedad Española de Informática de la Salud; 2007: 272 p.
  • 4 Spanish Ministry of Health and Social Policy.. Report: Quality Plan For The National Health System of Spain 2006-2010 –Review of activities to date and summary of future actions. Madrid: Spanish Ministry of Health and Social Policy; 2010: 68 p.
  • 5 Montesino M, González AS. Historia clínica informatizada: 8 años de experiencia en un servicio médico quirúrgico. Rev Calid Asist 2010; 25 (03) 173-180.
  • 6 González E, Pérez F. La historia clínica electrónica. Revisión y análisis de la actualidad. Diraya: la historia de salud electrónica de Andalucía. Rev Esp Cardiol Supl 2007; 7: 37C-46C.
  • 7 Project Management Institute.. A Guide to the Project Management Body of Knowledge (PMBOK® Guide). 4th ed. Newtown Square (PA): Project Management Institute; 2008: 459 p.
  • 8 Carnicero J, Blanco O, Mateos M. The application of information and communication technologies to clinical activity: Electronic health and clinical records. Pharmaceuticals Policy and Law 2005-2006 8: 69-82.
  • 9 Callen JL, Braithwaite J, Westbrook JI. Contextual Implementation Model: A Framework for Assisting Clinical Information System Implementations. J Am Med Inform Assoc 2008; 15: 255-262. doi: 10.1197/jamia. M2468.
  • 10 Trivedi MH. et al. Barriers to implementation of a computerized decision support system for depression: an observational report on lessons learned in "real world" clinical settings. BMC Medical Informatics and Decision Making 2009; 9: 6. doi:10.1186/1472-6947-9-6.
  • 11 Poissant L, Pereira J, Tamblyn R, Kawasumi Y. The Impact of Electronic Health Records on Time Efficiency of Physicians and Nurses: A Systematic Review. J Am Med Inform Assoc. 2005; 12: 505-516. doi: 10.1197/jamia. M1700.
  • 12 Bates DW. The road to implementation of the electronic health record. Proc (Bayl Univ Med Cent) 2006; 19: 311-312.
  • 13 Zandieh SO. et al. Challenges to EHR Implementation in Electronic- Versus Paper-based Office Practices. J Gen Intern Med 2008; 23 (06) 755-761. doi: 10.1007/s11606-008-0573-5.
  • 14 Lium JT, Tjora A, Faxvaag A. No paper, but the same routines: a qualitative exploration of experiences in two Norwegian hospitals deprived of the paper based medical record. BMC Medical Informatics and Decision Making 2008; 8: 2. doi:10.1186/1472-6947-8-2.
  • 15 Terry AL. et al. Implementing electronic health records: Key factors in primary care. Can Fam Physician 2008; 54: 730-736.
  • 16 Shekelle PG. Implementation of health information technology: an important but challenging field of inquiry. Proc (Bayl Univ Med Cent) 2006; 19: 313.
  • 17 McGowan JJ, Cusack CM, Poon EG. Formative evaluation: A critical component in EHR implementation. J Am Med Inform Assoc 2008; 15: 297-301. doi: 10.1197/jamia. M2584.
  • 18 Doebbeling BN, Pekny J. The Role of Systems Factors in Implementing Health Information Technology. J Gen Intern Med 2008; 23 (04) 500-501. doi: 10.1007/s11606-008-0559-3.
  • 19 Lorenzi NM, Kouroubali A, Detmer DE, Bloomrosen M. How to successfully select and implement electronic health records (EHR) in small ambulatory practice settings. BMC Medical Informatics and Decision Making 2009; 9: 15. doi:10.1186/1472-6947-9-15.
  • 20 Fullerton C. et al. Lessons learned from pilot site implementation of an ambulatory electronic health record. Proc (Bayl Univ Med Cent) 2006; 19: 303-310.

Correspondence to:

Javier Carnicero
Observatory of the National Health System
Ministry of Health and Social Policy
Office 1605
Paseo del Prado 18-20
28014 Madrid
Spain

  • References

  • 1 Spanish Ministry of Health and Social Policy.. National Health System of Spain Annual Report 2008. Madrid: Ministry of Health and Social Policy; 2010: 464 p.
  • 2 National Observatory for Telecommunications and the Information Society.. Information and Communication Technologies in the National Health System Report. Madrid: Spanish Ministry of Industry, Tourism and Commerce; 2010: 26 p.
  • 3 Carnicero J. compiler and editor. La gestión de proyectos de tecnologías de la información y de las comunicaciones en los servicios de salud –Informe SEIS (7). Pamplona: Sociedad Española de Informática de la Salud; 2007: 272 p.
  • 4 Spanish Ministry of Health and Social Policy.. Report: Quality Plan For The National Health System of Spain 2006-2010 –Review of activities to date and summary of future actions. Madrid: Spanish Ministry of Health and Social Policy; 2010: 68 p.
  • 5 Montesino M, González AS. Historia clínica informatizada: 8 años de experiencia en un servicio médico quirúrgico. Rev Calid Asist 2010; 25 (03) 173-180.
  • 6 González E, Pérez F. La historia clínica electrónica. Revisión y análisis de la actualidad. Diraya: la historia de salud electrónica de Andalucía. Rev Esp Cardiol Supl 2007; 7: 37C-46C.
  • 7 Project Management Institute.. A Guide to the Project Management Body of Knowledge (PMBOK® Guide). 4th ed. Newtown Square (PA): Project Management Institute; 2008: 459 p.
  • 8 Carnicero J, Blanco O, Mateos M. The application of information and communication technologies to clinical activity: Electronic health and clinical records. Pharmaceuticals Policy and Law 2005-2006 8: 69-82.
  • 9 Callen JL, Braithwaite J, Westbrook JI. Contextual Implementation Model: A Framework for Assisting Clinical Information System Implementations. J Am Med Inform Assoc 2008; 15: 255-262. doi: 10.1197/jamia. M2468.
  • 10 Trivedi MH. et al. Barriers to implementation of a computerized decision support system for depression: an observational report on lessons learned in "real world" clinical settings. BMC Medical Informatics and Decision Making 2009; 9: 6. doi:10.1186/1472-6947-9-6.
  • 11 Poissant L, Pereira J, Tamblyn R, Kawasumi Y. The Impact of Electronic Health Records on Time Efficiency of Physicians and Nurses: A Systematic Review. J Am Med Inform Assoc. 2005; 12: 505-516. doi: 10.1197/jamia. M1700.
  • 12 Bates DW. The road to implementation of the electronic health record. Proc (Bayl Univ Med Cent) 2006; 19: 311-312.
  • 13 Zandieh SO. et al. Challenges to EHR Implementation in Electronic- Versus Paper-based Office Practices. J Gen Intern Med 2008; 23 (06) 755-761. doi: 10.1007/s11606-008-0573-5.
  • 14 Lium JT, Tjora A, Faxvaag A. No paper, but the same routines: a qualitative exploration of experiences in two Norwegian hospitals deprived of the paper based medical record. BMC Medical Informatics and Decision Making 2008; 8: 2. doi:10.1186/1472-6947-8-2.
  • 15 Terry AL. et al. Implementing electronic health records: Key factors in primary care. Can Fam Physician 2008; 54: 730-736.
  • 16 Shekelle PG. Implementation of health information technology: an important but challenging field of inquiry. Proc (Bayl Univ Med Cent) 2006; 19: 313.
  • 17 McGowan JJ, Cusack CM, Poon EG. Formative evaluation: A critical component in EHR implementation. J Am Med Inform Assoc 2008; 15: 297-301. doi: 10.1197/jamia. M2584.
  • 18 Doebbeling BN, Pekny J. The Role of Systems Factors in Implementing Health Information Technology. J Gen Intern Med 2008; 23 (04) 500-501. doi: 10.1007/s11606-008-0559-3.
  • 19 Lorenzi NM, Kouroubali A, Detmer DE, Bloomrosen M. How to successfully select and implement electronic health records (EHR) in small ambulatory practice settings. BMC Medical Informatics and Decision Making 2009; 9: 15. doi:10.1186/1472-6947-9-15.
  • 20 Fullerton C. et al. Lessons learned from pilot site implementation of an ambulatory electronic health record. Proc (Bayl Univ Med Cent) 2006; 19: 303-310.